Provider Demographics
NPI:1639496052
Name:KING, ANDREA JO (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JO
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 NE 87TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-1854
Practice Address - Fax:360-514-6063
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD606474382086H0002X, 2086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care